Fighting malaria: a new way of thinking

The Battle Plan What’s the most dangerous animal on the planet? It’s not a lion, a shark or even a human. The world’s biggest killer is a mosquito and it’s putting up a hard fight.

Richard Allan

Founder and Director of the Mentor Initiative

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Malaria facts (click to enlarge)

According to the World Health Organisation (WHO) an estimated 438,000 people lost their lives to malaria in 2015 alone, which is a 48% decrease from the estimated 839,000 individuals who died from the disease in 2000.

Undeniably great progress has been made, but statistics only tell part of the story. 80% of all malaria cases can be found in just 18 countries mainly in West and Central Africa and here the problem is actually getting worse.

Richard Allan, Founder and Director of the Mentor Initiative, suggests that, “Many of the statistics are only estimations based on mathematical modeling from countries that are not representative of high transmission areas. In many cases, the number of deaths from malaria have actually increased.”

High Transmission Areas

The regions where the disease is most prevalent are those that have experienced humanitarian crisis and natural disasters. “In West Africa, the Ebola crisis essentially shut down the health systems for more than a year,” explains Mr Allan. “As a result, tens of thousands of people died from malaria and progress has been set back at least a decade.”

In many Central African countries, conflict remains the greatest barrier to overcome. Countries such as Burundi and South Sudan have had their infrastructure, healthcare systems and governance decimated by civil war. Combating malaria requires a completely different approach in countries where there is little structure or governance.

Even in stable countries, only about 50% of malaria treatment is administered through conventional public health facilities. Most people access care in their own community. This is even more evident in the 18 countries with the greatest burden. Where infrastructure is poor or non-existent, the focus needs to be on providing prevention, diagnosis and treatment at the village level, available 24 hours a day through a community worker.

A new way of thinking

The good news is that integrated vector management, through long lasting insecticidal nets, indoor residual spraying (IRS) and destroying mosquito larvae before they hatch, is working. These preventative measures, when used alongside rapid diagnostics and treatment through artemisinin-based combination therapy (ACT) can reduce incidence of the disease and the number of deaths.

The problem is that the effectiveness of many of these techniques is compromised by insecticide resistance and compounded by the challenge of delivering an effective programme in unstable and insecure environments.

Alternatives need to be found. There is evidence that robust strategies can work in every the toughest regions. Following its independence in 2011, funding poured into South Sudan and huge efforts were made to work directly with community leaders and equip local health workers to take the lead in fighting malaria.

“For three years there were no malaria epidemics in South Sudan,” confirms Mr Allan. “Despite an initial scale up of emergency funding by the international community, when civil unrest broke out again in 2014, funding for malaria control amongst displaced and conflict affected communities was almost completely cut by the start of 2015. In June last year the country experienced the worst malaria epidemic it’s ever had.”

Making change happen

WHO estimate that US$ 5.1 billion is needed every year if sustainable development goals are to be met. Mr Allan points out that, “on average countries where it’s easy to work have been receiving twice as much funding per beneficiary compared to those 18 countries that hold 80% of the burden. In these countries funding needs to be not just doubled, but multiplied three or four times to correlate with need.”

If progress is to be made, intervention must be made on the basis of need, rather than the ease with which a country can respond. With the right knowledge and tools, the only thing preventing action is the willingness to invest money, time and energy on behalf of those who live in the world’s most challenging countries.